It’s one thing to look at America’s health care system as a business leader, legislator, or administrator. It’s quite another to look at it as a patient or a parent.
That came into sharp focus when both of my children were born more than five weeks prematurely and suffering from respiratory distress syndrome. Long days became even longer nights in the hospital neonatal intensive care unit. Fear, anxiety, and questions swirled. What are we supposed to do when we get home? What if they stop breathing? Are they going to be OK?
Today, both children are healthy and thriving, thanks to health care advancements and the care provided by an outstanding team of doctors and nurses. And the fact that we had insurance coverage meant that taking a financial hit wasn’t one of our worries. Millions of parents and patients ask questions just like ours every day. They are central to the debate over health care in America. And they encapsulate the tough questions I get every day as president and CEO of the trade association representing America’s health insurance providers.
Personal, intimate interactions too often collide with a complicated, confusing health care system. Yes, it’s essential to find big-picture solutions that help manage costs for governments and businesses and improve the effectiveness of treatments. But we must never lose sight of our collective mission to ensure that all Americans get the care they need when they need it, at a cost they can afford, with help at the ready to make the experience of navigating our health care system simpler and better for patients and their families.
It starts with making health care more affordable. New transformative therapies must come with a reasonable price tag. We cannot continue to pay ever-higher prices year after year. Without real competition in prescription drugs, among health care systems and doctors, and for other products and services that are needed for better health outcomes, health care prices and costs will continue to grow faster than the rest of our economy. It will become harder to shield businesses and patients from those costs. And those health care costs will crowd out other key national priorities like education, infrastructure, and higher wages.
Affordable coverage requires us to accelerate innovation. That’s why insurance providers are leading new collaborations with doctors that reward the quality of the care they deliver, not the quantity of care they provide. Insurance providers are also investing in new business partnerships and technologies and embracing new problem solvers from outside health care. Health insurers want to partner with anyone who shares our goal of making health care more efficient and effective.
Today, nearly 300 million Americans have health insurance coverage. That helps ensure they have access to preventive services and other care, which helps them get healthier faster and stay healthier longer. People with pre-existing conditions such as diabetes, asthma, or cancer are no longer charged more for health insurance, nor can they be denied coverage. Out-of-pocket costs for patients have declined as a share of total costs, as private plans in commercial, Medicare, and Medicaid programs have become more comprehensive and efficient.
Yet, even with all this progress, there’s still work to do. Health insurers are committed to doing our part and bringing together everyone with a stake in health care who can make things easier for those who try to navigate the system every day. We need to welcome new, diverse voices, as well as embrace innovation from within and outside health care. By having the smartest minds from traditional health care businesses as well as those separate from the industry, we challenge ourselves to think differently to improve health care quality and affordability.
That means collaborating with leaders in the public sector to simplify rules and regulations to make it simpler for Americans to get the care they need when they need it. It also means working with doctors, hospitals, and drug companies to ensure that patients receive care that will make them healthier faster, and keep them healthier longer. That kind of collaboration is the only way we can meet our commitment to ensuring that all Americans get the care they need without breaking the bank.
I’ve experienced the health care system from many sides. But my experience as a father and family member is what drives me to welcome evolution in our industry and push for change across the health care system. New voices challenge us to think differently about how we can offer more choices to Americans to improve the quality of their health care, lower their health care costs, and create peace of mind.
Matt Eyles is president and CEO of America’s Health Insurance Plans, the national trade association representing health insurance providers who cover millions of Americans.
Health care is counter to traditional market models. Because technology is so costly, competition does not foster downward price pressure. It’s just the opposite. More competition means fixed costs are spread over fewer consumers, raising the cost of service. Add to that the inability to even price shop when there’s a true medical emergency (think accident, cardio-vascular event) and you have a recipe for pricing he’ll. The ACA did nothing to address the root cause of insurance unaffordability, ever escalating costs. Tell me again why medicines and devices that are off patent carry the costs they do (other than its unlawful for Medicare, the single largest purchaser, to negotiate price?
Insurers and health plans have a deep and abiding collective action problem. Everyone in the US health care system wants it to be more effective, fairer and less costly. The information needed to make that happen can only be provided by studying what interventions cost, what benefits they provide and paying for what works and not paying for what does not. But generating that information is perilous. One need merely observe the many near-death experiences of the National Center for Health Services Research/Agency for Health Care Policy and Research/Agency for Healthcare Research and Quality (AHRQ and its predecessors) in the US, the dalliance with elimination of the National Institute for Health and Care Excellence (NICE) in the UK several years back, and the ongoing contentious politics of the Institute for Clinical and Economic Review (ICER) in the US. Yet information about what is not worth paying for is among the most valuable things to know, and therefore socially valuable to produce. But the danger is undermining incentives for real innovation that does improve health care, including new goods (e.g., drugs, devices, biologics, vaccines) and services—or better ways to deliver them. Until and unless the major stakeholders—particularly payers and providers—create a safe place to study the system and insulate it from the immensely well financed politics of inertia, prospects for moving toward a more effective and less expensive system are dim.
The only other component of Health that was not included as a partner is the community that provides prevention interventions that have an impact on the total cost of care. Payment for Tobacco Cessation, incentives for the insured to live a healthy lifestyle inclusive of physical activity and nutrition.